California > Local County > San Joaquin > Probate

Status Report On Conservatee CI-12 - California

Status Report On Conservatee Form. This is a California form and can be used in Probate San Joaquin Local County .
 Fillable pdf Last Modified 2/14/2011
Get this form for FREE as a print-only pdf

SUPERIOR COURT INVESTIGATORS 2826 SUPERIOR COURT OF SAN JOAQUIN COUNTY In The Conservatorship of: PHONE: (209) 468FAX: (209) 468- REPORT TO THE COURT ON THE STATUS OF CONSERVATEE CASE NUMBER I, _____________________________am the Conservator of the above-named Conservatee and my status report is as follows: 1. Present age of the Conservatee: ____________ Conservatee's Date of birth: ______________ 2. Current Living arrangements of the Conservatee: A. Name of care facility/board and care: _________________________________________ B. Current address: _________________________________________________________ _________________________________________________________ C. D. Phone number of Conservatee: __________________________________________________ The Conservatee's residence is own home/apartment Conservator's home/apartment nursing home hospital or medical facility boarding home relative's home (relationship) ________________ other (specify)__________ The Conservatee has been in the present residence since (date):_____________. If moved within the past year, state reason(s) for change: ____________________________________________ I rate the Conservatee living arrangement as Excellent Average Below average (Explain)_____________________________________________________________________ I believe the Conservatee is: content with the living situation unhappy with the living situation I recommend a more suitable living arrangement for the adult as follows: ________________________________________________________________________________ ________________________________________________________________________________ E. F. G. H. 3. Physical Health A. I believe that the Conservatee's current physical condition is Excellent Good Fair Poor B. During the past year the Conservatee's physical condition has: remained about the same improved (Explain) _________________________________________________ worsened (Explain)_________________________________________________ C. During the past year the Conservatee received the following medical treatment; (Include check-ups and dental): Date Ailment Type of Treatment Doctor's Name __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ __________________________________________________________________________________ CI-12 (01/11) STATUS REPORT ON CONSERVATEE CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com 4. Mental Health A. I believe the Conservatee's current mental condition is Excellent Good Fair Poor B. During the past year the Conservatee's mental condition has: remained about the same. improved (Explain) _________________________________________________________ worsened (Explain) ________________________________________________________ C. During the past year, treatment or evaluation by a psychologist or social worker: was provided was not provided __________________________________________________ D. IF conservatee is a client of Valley Mountain Regional Center please provide: (Case Manager Name):_________________________________ (Phone Number):___________________ 5. Social Activities/Services A. The conservatee's social condition is Excellent Good Fair Poor B. During the past year, the Conservatee's social condition has: remained about the same improved (Explain) ______________________________________ C. IF conservatee participates in a day-program please provide Name of Program: ______________________________________________ Address: _____________________________________________________ Phone Number: ________________________________________________ D. During the past year, the Conservatee has participated in the following activities: Recreational _____________________________________________________________________ Educational ______________________________________________________________________ Social ___________________________________________________________________________ Occupational _____________________________________________________________________ Other organizations/programs the Conservatee participates in; describe: ______________________ ___________________________________________________________________________________ If the conservatee does not attend a day-program, please explain why: ________________________ ____________________________________________________________________________________ 6. List of Visits Please check this box if the conservatee lives with the conservator. A. The last visit to the conservatee was on __________. During the past year, I visited the Conservatee as follows:_____________________________________________________________________________ _____________________________________________________________________________________ B. The average amount of time I spent on each visit was: _______________________________________ 7. I intend to change or I request the court to be able to change the following: A. The Conservatee's living arrangement (describe);___________________________________________ ______________________________________________________________________________________ B. The current financial management of estate including the sale of any assets (describe); ______________________________________________________________________________________ ______________________________________________________________________________________ 8. The conservatorship should be should not be continued because: ______________________________________________________________________________________ ______________________________________________________________________________________ 9. A. I am the Conservator of the Person Only for the Conservatee. B. I am the Conservator of the Person and Estate and my accounting will be filed separately. ___________________________________ Address: ___________________________ Check if (Signature) _____________________________________ _________________________________________________ (Date) new address Phone: ___________________________ Check if new phone # CI-12 (01/11) STATUS REPORT ON CONSERVATEE CONFIDENTIAL American LegalNet, Inc. www.FormsWorkFlow.com
Link/Embed this Document
URL
Embed


Popular Searches

  1. notice of appeal
  2. proof of service
  3. child custody
  4. divorce
  5. affidavit of service
  6. complaint
  7. power of attorney
  8. JUDGMENT
  9. answer
  10. default judgment

Bookmark and Share